HomeMy WebLinkAboutSWG2021-00603 - SWG As-Built - 12/19/2024 r ,
Mason County OSS Installation Report pg. 1 MASON COUNTY PUBLIC HEALTH
APPLICANT/PERMIT INFORMATION
Permit Number SWG 2021-00603 Parcel# 321275100175
Applicant Name King Homes Subdivision (Name/Div/Sl1WLot)
Applicant Address PO BOX 547
City,State,Zip Olalla We.98359 Installer Name Timbedine Fx avafing LLC
Site Address 391 E Road of Tralas Designer Name Bred Smith
INSTALLATION CHECKLIST
Full System Installation ❑Tank(s)Only ❑Dralnfield Only ❑Repair ❑Oilier
System Type Oscar xo2 Pr
nt Type
>5 fL from foundation? -----____.� l
>50 R.from wells? ---- ------ ��J WA ��8 ❑ no
Y >50 R from surface water7 ----___ -_------ ® ❑
Cleanout between building and tank? • _• �Z-2M- x ❑
U Tank baffles present? --________ _ ___-_-___�_ ® ❑
LL24'access risers over each companme ❑
H Effluent fitter inacalled?- ____________ ■ ❑ ❑
Septic tank capacity(working) 1000 gal Manufadmer Hagerman
D-box water level and speed levelers used? ------________.
CLLManifold/0-box accessible from unecs?--___-__ ■ ❑ ❑ No
z --- - ❑wA ❑ ❑
06 Check valves installed? ------------------------- - ❑ ❑
f Transport Line Size Schedule/Class ❑
Bedrooms installed(check one) ❑2 ®3 ❑4 ❑5 ❑e ❑CommerclaVOther
>10 ft from foundation?--------------------------- ❑ NIA yea
C. .>700ft.from wells?------_- -__- ❑ No
_-_____-___ ❑ ❑
rj . >100 R.from surface water?------------------------ ❑ e El
>10ft.from potable water lines?.--------------------- ■ ❑
>5 ft.from property lines and easements?--------------- - ❑ .0 ❑>30 ft.from downgradient wrtain/foundadon drains?•----____. ❑ ❑
Drainfield level and observation ports present -- ---________- ❑ ® ❑
❑ Graveless chambers or ❑ Clean gravel used? (check one)
Proper cover installed over dreinfield?------------------ - ❑ ❑
Pump tank setbacks consistent with septic lank?------------- ❑ wA dyes ❑ NO
2 Pump tank capacty(Food) 1000 at Manufacturer Hagerman
24-access risen(s)and accessible from surface?- ....... . ❑ ■ ❑
y Alarm or Control Panel Installed?-__________________.-- ❑ ® ❑
j Cononl Panel equipped with riims,/ETM/Cwnter---------
_- ❑
a Pump installed in Bucket or ❑❑ ❑ On Bock or ® Other Turbine on floor of tank
a Pump Make/Model Lot 30
F . Floats or ❑Transducer
y Tank draw down N/rINmin Pump capacity r /
Pm Squirt Height
Pump on time 7JLS� Pump off timei £G Daily flgw set et -- pd
Vr4M Nt1iMIB
Mason County OSS Installation Report pg. 2 Parcel11 321275100175
ADANDONMENTRECORD
Were existing sepllc components abandoned as part of this project? --------------- .� ® NO
If yes,please collate:
Were ell components Pamped out and property abandoned per WAC246272A-0300? ------- . 0 YES � No
RECORD DRAWING
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Record Drawing Attached
CERTIFICATION OF INSTALLATION -
INSTALLER DESIGNER/ENGINEER
I cattily that I instaged the system in accordaxe with I Certify that the system has been installed in accor-
the septic design stamped"APPROVED-by Meson dance wen the septic design stamped"APPROVED'by
County Public Haetth and that any deviations shown Mason County Public Hearth and that any deviations
here have been Cieeredfapprved by both the designer shown here have been clearedrappromd by both
and Mason County Public Health and meet all State myself and Mason County Public Health and meet all
end Mason County Codes. State and Mason County Codes
I further Canty that all information contained on this 1 further certify that all lnfomlesm contained on this
form antl attache/Record Drawing is accurate. form and attached Record Drawl ie accurate.
Atw &— liby(2041
Sgnature ollnsfafler Data
TAIr C4gw4r-
Printed Nameor Slgnee N HRH^
MASON COUNTY PUBLIC HEALTH
The undersigned apprves this Installation Report and �•.}_J
Record Drawing on behallof Mason County Public
Health:
e> Jl ze-u
Signature of Eavimnmemai Heaah Spscteliat Dete (Stamp,signature and date)
THIS FORM MAYBE 3CANNEDANDAVAILABLE FOR PIIRLICVIEWON THE MASON COUNTY WEB RRE uwwna WI.R
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